Book SummaryThe Emperor of All Maladies, by Siddhartha Mukherjee

1-Page Summary1-Page Book Summary of The Emperor of All Maladies

The Emperor of All Maladies by Siddhartha Mukherjee is an overview and rough timeline of the fight against cancer. The book’s subtitle, A Biography of Cancer, reflects Mukherjee’s feeling that cancer is a living and evolving entity—an entity that fought modern medicine to a stalemate for hundreds of years. Mukherjee, a doctor and biologist who specializes in immunology (the study of the immune system) and oncology (the study of cancer), has spent much of his career on the front line of that fight. Though _The Emperor...

The Emperor of All Maladies Summary What Is Cancer?

Mukherjee says that cancer is, essentially, a corruption of our biological processes; the functions that normally keep us alive and healthy instead work to build and repair deadly tumors inside our bodies.

In simple terms, cancer is uncontrolled cell division. Mitosis is the process of cells dividing to create new, identical cells—it’s how we grow and how our bodies repair damage. Normally mitosis is strictly regulated by biological signals that control when it starts and when it stops, but cancerous cells don’t respond correctly to those signals. As a result, they replicate quickly and endlessly, eventually amassing in a tumor.

The author adds that it’s crucial to understand cancer is not a single disease, but a type of disease—for instance, lung cancer and leukemia are both cancers, but they have different causes, symptoms, and...

The Emperor of All Maladies Summary Pre-1900s

Understanding Cancer

Until relatively recently, doctors didn’t truly know what cancer was or how it occurred, let alone how to treat it. Therefore, a great deal of the history of cancer research is just trying to answer those basic questions about the disease.

Mukherjee says that cancer has probably existed for as long as our species has—for example, a human jawbone dated to approximately 2 million BC shows signs of a cancerous tumor invading it. However, cancer was extremely rare until recently because most people died young, and cancer rates increase exponentially with age.

In 130 AD the Greek physician Galen asserted that an imbalance of black bile in the body causes cancer. While Galen was wrong (in fact, there’s no such thing as “black bile”), Mukherjee says this theory was remarkable for recognizing that cancer is a systemic issue (affecting the entire body) rather than a localized tumor. Modern medicine wouldn’t rediscover that fact for nearly two millennia.

(Shortform note: Galen’s black bile theory—and the fact that it was clearly disproven later—illustrates an important point about scientific advancement: As Thomas Kuhn explains it in _[The Structure of...

The Emperor of All Maladies Summary 1900-1950

Advancements in Understanding

Mukherjee tells us that, in 1914, biologist Theodor Boveri observed that cancer cells all have chromosomal abnormalities: damage or mutations in the cell’s DNA. He theorized that chromosomal damage causes cancer.

What Is DNA?

Boveri’s discovery in 1914 was the beginning of what we know about cancer today: It’s a corruption of our DNA. Therefore, to understand cancer, you must first understand what healthy DNA does, and how.

Your genes are made of DNA (deoxyribonucleic acid). It’s like a cellular blueprint: DNA carries instructions on how to create proteins, which your body then uses for countless functions such as repairing tissue damage and transporting nutrients where they’re needed. Some of those proteins also help with the process of mitosis, replicating the DNA and helping the cell to divide in order to create new cells.

If the DNA gets damaged or mutated, those instructions become garbled. In rare cases, they become garbled in such a way that the cell goes haywire: Mitosis...

The Emperor of All Maladies Summary 1950-2010

Advancements in Understanding

According to Mukherjee, the period from 1950 to 2010 saw researchers working to understand and treat cancer at the microscopic level. Many doctors believed that the key to curing cancer lay in discovering which genes were mutated in cancer cells, and what specific effects those mutations had. They hoped that, by learning exactly how cancer works, they could find new ways to stop it.

Mukherjee says that cancer was clearly and thoroughly defined for the first time in 1999, when biologists Robert Weinberg and Douglas Hanahan created a list of six qualities that all cancer cells possess:

1. Automatic mitosis. Cancer cells don’t need chemical signals to divide; they’re always “on.”
2. Non-responsive to antigrowth signals. Cancer cells do not respond to chemical signals that normally stop cell division.
3. “Immortality.” Cancer cells do not respond to chemical signals that normally trigger cell death (called apoptosis).
4. Limitless replication. Normal cells can divide a limited number of times; cancer cells bypass this limit, allowing for apparently infinite cell division.
5. Self-sustaining. Cancer cells induce...

The Emperor of All Maladies Summary The Social Aspects of Cancer

Although a lot of The Emperor of All Maladies is about the history of cancer research and treatment, Mukherjee says that we mustn’t focus so much on the disease that we lose sight of the people. After all, curing cancer isn’t just an interesting puzzle to solve—fighting cancer is about helping people.

Considering the Person, Not Just the Disease

In the 1950s, an English physician named Cecily Saunders introduced the idea of palliative medicine to cancer treatment: end-of-life care designed to preserve comfort and dignity, rather than cure the disease at any cost.

Mukherjee says that, despite its name, palliative medicine was more of a social advancement than a medical one. Many doctors had refused to even consider palliative care because it felt like admitting defeat; furthermore, many people fought for the slightest chance that their loved ones could be healed, no matter the cost or the impact on the patient. However, Saunders argued that subjecting patients to painful and nauseating treatments with little hope of curing them did more harm than good—that there came a time when doctors and loved ones should let the patient stop suffering and die peacefully....

The Emperor of All Maladies Summary The Good News

Cancer is a difficult topic with a bleak history, but Mukherjee does have some good news for us: From 1990-2005, cancer mortality declined by about 1% per year—an unprecedented 15% decrease overall. Mukherjee says that this decrease was the result of earlier advancements in cancer prevention, screening, and treatment, such as the pushback against the tobacco industry in the 1960s and 1970s....

Shortform Exercise: Witness the Ongoing Battle Against Cancer

Reflect on how you experience the evolving fight against cancer.

How has public understanding and the societal discussion of cancer changed during your lifetime?